Spinal Manipulation Improves Pain Sensitivity

Spinal manipulation (SMT) is most commonly used to treat musculoskeletal pain.  While there has long been question over exactly how SMT helps, numerous studies, as well as countless individual accounts, show that it is indeed effective.  

As science and medical research progresses, more light is being shed on the science that lies behind how spinal manipulation impacts pain sensitivity. 

In a study1 released in 2012, researchers gathered available literature to review and integrate into a cohesive report.  The review was conducted in accordance with guidelines from Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) and the Cochrane Back Review Group [Furlan et al, 2009; Liberati et al, 2009]. 

They focused attention to changes in pain sensitivity following SMT as well as factors which may have impacted the assessment including sample population (clinical or healthy) and location of measurement (at site of SMT or remote to SMT).  Previous studies have pointed to both biomechanical and neurophysiological changes as a result of SMT.  Therefore, researchers determined that pain sensitivity testing is valid to measure response to SMT. 

This type of testing includes the “sensory modality used, the psychophysical response, and the location of stimulus application.”2,3  Pain sensitivity is then “measured through the application of different sensory modalities, such as thermal, mechanical, electrical, ischemic and chemical stimuli, to different tissues of the body.”  2,3  Measurements are recorded before as well as immediately after and may be taken both at the site of (or a site near) the injury, at a site away from the injury and where the intervention is applied.  

“Changes in pain sensitivity at the site of application of SMT, but not at remote regions, would indicate the effects of SMT are specific to the location of application. On the other hand, remote changes may be indicative of a more general effect . . . within the central nervous system.”  

After initial review, 20 articles reporting on 20 separate studies (with a total of 974 participants) met all criteria for the review.  Of the studies, eleven were conducted with healthy participants and nine included symptomatic participants.  Participants ranged from 21-42 years old with the symptomatic participants tending to be older (mean age 30-42 years old).  Roughly half of the studies aimed at SMT of the cervical spine (11), and the other half split between thoracic and lumbosacral (5 each).  One study included both cervical and thoracic SMT. 

After reviewing and analyzing the gathered literature, researchers concluded: “SMT has a favorable effect on pain sensitivity.” 

They did not find a significant difference in the effect of SMT between healthy and clinical participants.  They noted a positive change for pressure pain threshold (PPT) at remote sites and a similar, but small change at local sites, further supporting a “possible general effect of SMT beyond the effect expected at the local region of SMT application.”  

In further meta-analysis of 10 studies examining the immediate effect of SMT on PPT, the results “suggested a small, but favorable effect of SMT on increasing PPT as compared to other interventions.”  Studies such as this, confirming SMT alters pain sensitivity, point to potential mechanisms that may account for the clinical effectiveness of SMT. 

Among chiropractors and their patients, it is common knowledge that SMT is an effective treatment for many types of pain.  Numerous studies have shown this to be true and HOW it works is also being examined by scientific researchers. 

These studies help open doors to educate the public and other health care providers to the benefits of chiropractic care while also helping the chiropractic community further fine tune recommendations and techniques in order to provide the best possible care for patients.

Learn more about the safety and effectiveness of chiropractic care as demonstrated by research as well as more studies on various wellness related topics at https://www.tnchiro.com/research/ and https://www.tnchiro.com/articles/ The TCA website has new articles and research added regularly.

If you are experiencing musculoskeletal pain, see your local chiropractor for an exam and consultation to determine how you can benefit from chiropractic care.  Your doctor of chiropractic will recommend a treatment program tailored to your specific health condition and needs. 

As part of a whole health approach, you may also receive exercises, stretches and/or dietary suggestions to help your body heal faster and maintain a healthy lifestyle.  If you need help finding a doctor near you, click here.


  1. Coronado, R. Gay, CW et all. Changes in Pain Sensitivity following Spinal Manipulation: a Systematic Review and Meta-Analysis. 2018; Journal of Manipulative and Physiological Therapeutics – Published online May 26, 2018
  2. Arendt-Nielsen L, Yarnitsky D. Experimental and clinical applications of quantitative sensory testing applied to skin, muscles and viscera. Journal of Pain. 2009;10(6):556–572.
  3. Staahl C, Drewes AM. Experimental human pain models: a review of standardised methods for preclinical testing of analgesics. Basic & Clinical Pharmacology & Toxicology. 2004;95(3):97–111.

This article is being shared as part of TCA’s
“Realign Your Thinking” public-awareness campaign – 
helping Tennesseans understand what chiropractic care offers
and the positive role it plays in the overall health care system.